WEEK 8 Flashcards
Describe rehabilitation following myocardial infarction
M O N T A C/T/P
State the benefits of aspirin therapy in patients with ischaemic heart disease.
- Heart rate - Exclusively NDHP like Verapamil/Diltiazem
- Reduce contractility (NDHP)
- Reduce afterload (DHP)
- Increases diastolic perfusion time (NDHP)
Discuss the strengths and weaknesses of beta adrenoceptor antagonists.
STRENGTHS
Decrease major determinants of myocardial oxygen demand
- Heart rate – reduce myocardial workload
- Decrease contractility
- Decrease systolic wall tension – improve relaxation
- Increases diastolic perfusion time
- Reduces rate of ischaemic events and mortality
WEAKNESSES
- Asthma
- Peripheral vascular disease
- Acute heart failure
- Bradycardia or heart block
- Fatigue
Discuss the strengths and weaknesses of calcium channel blockers.
STRENGTHS
- Heart rate - Exclusively NDHP like Verapamil/Diltiazem
- Reduce contractility (NDHP)
- Reduce afterload (DHP)
- Increases diastolic perfusion time (NDHP)
WEAKNESSES
- Peripheral oedema (DHP)
- Bradycardia/heart block (NDHP)
- Hypotension (Both)
- Reduced LV function
- Headache
- Flushing
Recognise the common complications of myocardial infarction.
- New-onset mitral regurgitation
- Ventricular septal rupture
- Left ventricular aneurysm
- Arrhythmias
- Emboli
Understand the treatment of myocardial infarction
RATE LIMITING
- Beta-arenoreceptor antagonist
- Calcium channel blocker (L-type)
- Ivabradine (f-channel)
VASODILATORS
- Nitrates - NO
- Calcium channel blockers
- Potassium channel activator
SODIUM CHANNEL ACTIVATORS
- Ranolazine
Discuss the strengths and weaknesses of thrombolytic therapy.
STRENGTHS
- More effective than pharmacological treatment
WEAKNESSES
- Prior intracranial haemorrhage
- Known intracranial lesion
- Ischaemic stroke within 3 months
- Suspected aortic dissection
- Active bleeding
Significant closed head trauma (<3 months)
Describe the clinical presentation and initial management of ruptured abdominal aortic aneurysm
PRESENTATION
- Abdominal/back pain
- Collapsing
- Pulse near lower abdomen
MANAGEMENT
- CT angiogram (if possible)
- Activate major haemorrhage protocol
- Analgesia
- Make calls
Describe common sequalae of aneurysms
- Rupture- risk related to size- high morbidity/mortality
- Occlusion –> ischaemia- Risk of limb loss
- Distal embolization (trash)
Strengths of IVABRADINE - rate limiting
- Heart rate – when in sinus rhythm
- Reduces rates of infarction
Strengths and weaknesses of vasodilators
STRENGTHS
1. Reduce preload and afterload – Therefore myocardial workload
2. Improve coronary flow via vasodilation (Epicardial arteries and improve blood supply)
WEAKNESSES
1. Doesn’t reduce mortality
Strengths of SODIUM CHANNEL ACTIVATORS eg Ranolazine
- Reduced O2 demand due to reduced wall stress (easier to perfuse microcirculation)
- Beneficial antiarrhythmic effects via Na+/K+ channels (uncertain utility).
Define pathophysiology of dissection and the broad classification systems of each
DISSECTION
- Tear in the inner wall of the aorta
- Blood forces walls apart
- Acute - medical/surgical emergency
TYPE A
- classification system of ascending aortic dissection
TYPE B
- Any other dissection that does not involve the ascending aorta
Describe the clinical presentation of Acute Thoracic aneurysm
ASYMPTOMATIC
BASED ON LOACTION OF ANEURYSM
- shortness of breath
- dysphagia and hoarseness
- back pain
- symptom of dissection
- pulsatile mass
Describe the clinical presentation of Acute Aortic dissection
- Chest pain (severe, sharp, radiating to back)
- Collapse (tamponade, acute AR, external rupture)
- Stroke (involvement of carotid arteries)
